Advocate Health Care. PURPOSE: Describe briefly the overall purpose of this position, i.e., Why does it exist?

Transcription

1 4/24/2012 Advocate Health Care Title: Practice Operations Coach PURPOSE: Describe briefly the overall purpose of this position, i.e., Why does it exist? The purpose of this position is to provide subject matter expertise, consultation and education to Advocate Physician Partners/Advocate Health Partners physician members on the following topics: ambulatory office patient care process work flow improvements, ambulatory efficiency and hospital utilization management, diagnosis coding improvement to insure accurate physician profiling, updates and communications relating to office EMR enhancements, and other initiatives supporting AdvocateCare and Clinical Integration. The Physician Performance Coach is dedicated to working with physicians and physician office staff to improve performance on key AdvocateCare outcomes which drive organizational performance improvement. The incumbent, by carefully analyzing available medical economics, quality and other data, will identify opportunities for improvement and develop and implement actions plans with a goal of helping the physician improve his or her practice performance relative to key AdvocateCare metrics and PHO capitated contracts financial performance. The PPC will provide in depth coaching to physicians and office staff members of assigned practices to develop their specific performance improvement plan. I. ACCOUNTABILITIES AND JOB ACTIVITIES: A. Hold regular coaching sessions with identified APP physician members to help them meet various AdvocateCare and Medicare ACO goals, share performance data and results and jointly develop improvement action plans. 50 % 1.Coaching sessions include the following topics: patient attribution methods, patient opt in or out processes, tactics for controlling cost of care, reductions in admits/1000 and length of stay, reducing unplanned patient readmissions, tactics for avoiding ambulatory sensitive admissions, meeting the HITECH Meaningful Use requirements, excelling performance in the clinical CI measures as well as the CMS ACO outcome measures (total measures this postion coaches physician performance on is over 100 CI measures and 65 CMS ACO measures, although more will be developed), how to improve physician profile, updates and communications relating to office EMR enhancements. 2.Direct the physician to other key APP resources to assist with performance improvement, such as PHO medical director, PHO Director, Provider Relations or Quality Improvement staff, etc. 3.Provide the physician with specific recommendations on improvement action plans.

2 4/24/ Provide full and complete explanations about the various APP incentive programs to physicians. 5.Jointly, with the physician,decide on next steps, including the next period for feedback on performance 6.Share with the physician reports, displays and dashboards that quickly identify the drivers of performance issues 7.Meetings primarily are held face to face with individual physicians, in order to maximize the exchange of information and ideas specific to the particular physician circumstance. B. Development of monitoring and feedback programs for physician performance on key AdvocateCare initiatives. 25 % 1.Support the development of tools to assist APP physicians in meeting various Advocate/Care goals, including educational materials for patient offices and patients, alerts and reminders and APP newsletter articles, embedded decision support tools within, the electronic referrals system, EMR and CIRRIS systems, as well as others to be determined. 2.Oversee the development and production of electronnic dashboards and reports and other helpful and unique displays that provide the physician with information on his or her performance on a regular basis and which can be used during 1:1 coaching sessions with the physician and his/her staff. 3.Develop plan for monitoring physician performance on the AdvocateCare incentive measures, including physician and physician practice group utilization, financial performance and clinical measures, with a special focus on on results relating to AdvocateCare (including FFS and HMO full risk contacts) and Accountable Care organization attributed patients related performance.

3 4/24/2012 C. Apply knowledge of business and analytics to provide information to physicians, senior and executive leaders.complete extensive analysis of the available AdvocateCare metrics, claims data and other data in order to understand the specifics of what issues are driving the outcomes and financial results. Skills and Experience: 1. Demonstrated excellent relationship management skills. 2. Demonstrated excellent negotiation skills. 3. Strong project management & strategic thinking skills. 4. Strong organizational skills. 5. Significant knowledge of hospital and physician (multispecialty group, IPA or PHO) operations and services impacted by managed care and health care reform. 6. Significant knowledge about both the clinical and financial aspects of managed care, including capitation and global budgets. 7. Demonstrated experience in preparing and delivering written and oral reports. 8. Strong skills for using various information systems tools to identify performance improvement opportunities, communicate these opportunities to physicians and track improvements. 1. Master s Degree or equivalent in relevant area years experience in performance improvement, operations, finance, marketing experience with at least 2 years in a relevant physician / hospital / managed care environment. 3. >2 years experience working collegially with physicians. 4. Experience in managed care/capitation/global budgets for the provision of health care services. 1. Daily local travel to physician offices. 2. Some early/late evening meetings.

4 Assessment Examples Advocate Health Care October 5, 2012

5 Assessment Tool Sample Practice: Date: General Waiting Room Scheduling APP HIGH PRIORITY PRACTICE OFFICE ASSESSMENT TOOL ADVOCATECARE INDEX FACTOR: PATIENT EXPERIENCE Appearance? Website? How far is office from Hospital? How far is office from ACL? Patient Information? New patient Brochures Policies Posted? Busy? Posted Office Hours Accurate? Meeting Standards? Open Slots Available Daily? ADVOCATECARE INDEX FACTOR: PHYSICIAN ENGAGEMENT Membership Capacity? Covering Physicians? COMMENTS/ RATINGS COMMENTS/ RATINGS 2 Involvement Hospital Physician Relations New Physician Onboarding? Completes CI In Person or Online? AdvocateCare Concepts Mastered? IConnect? Hospital Complaints? Pending Transactions?

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7 Action Plan Samples Advocate Health Care October 5, 2012

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10 Advocate Medical Group Action Plan Issue Solution 1 Solution 2 Solution 3 Solution 4 Solution 5 Responsible Part Timeline NOTES ER Visit Frequency Determine each Practice's Access. Identify that OCMs are Morning/evening given this list and have weekend hours. After contacted the patient hours call service Telephonic Visits, Walk in, same day appts Materials posted in practice/rooms on what to do before the ER(i.e. phone # to call) Marketing of Walk-in hours, UC, OCMs, PCPs, Marketing Dept Can OCMs see who visited the ER previous day? ER Non-Emergent (levels 1,2,3) Educate patients about Urgent/Immediate Care Resources Materials posted in practice/rooms on what to do before the ER(i.e. phone # to call) Practice Managers/Directors given list of PCPs with high # of utilizers to work with PCP Robust Triage System Blackbox Technology for info posting at big sites Practice Directors/Mgr, Marketing, Admin, PCPs, OCM Local management work with high ER PCPs and Out of Network PCPS. What to do about code 780. Levels 1-3 make up 50% of visits ER Chronic Patient lists given to pharmacy and quality to work with asthmatics, diabetes, etc. Utilize Home Health for homebound patients Postings of Benefits of w/active mgt not going to ED Track missed appointments. Active outreach to consistent appointment failures Phytell (patient outreach system) OCM, Pharmacy, Quality, Home Health, Appt Sch., Marketing, Admin, PCPs Southside most prevalent for all ER users ER Out of Network Education explaining benefits of staying in System Immediate F/Up day after for reasons Urgent Care/Immediate Care System showing local ER/UC wait times Expansion of more UCs in the other markets OCM,Admin, Marketing, PCPs Patient Portal to post infomration?? ER Pediatrics Pediatric Triage (no missed calls) Cross-coverage Urgent Care/Immediate Care Patient Education Specific OCM, i.e. Asthma specialist Admin, OCM, PCPs 4

11 Admissions Determine protocol for ER docs and PCPs Work with pharmacy, quality, and OCM for patient mgt Utilize observation visits when appropriate ED Dept, PCPs, Pharmacy, Quality, Hospitalists 20% of Admits involve L&D,OB Readmissions ER/Inpatient CM make OCM receives patient F/Up Appts name to contact Appointment scheduling confirms appointment day/time Phytell Hospitalists Coordination of f/up care ICM, OCM, Appt Sch, Hospitalists, PCPs, Admin biggest age group Length of Stay Expand use of hospitalists Additional documentation/coding training specific to specialty Round primarily in the mornings Increase communication with ICM Hospitalists, PCPs, Coding, ICM, Admin Inpatient Out of Network Increase Marketing Outreach about Advocate Hospitals. Reduce Out-Network ER Refer to AMG/Advocate Specialists System showing local ER/UC wait times Education Explaing Benefits of Staying in System Home Health Marketing, Home Health, PCPs, Specialists, Admin 80% of Admits In-Network 5

12 Physician Performance Expectations - AMG Advocate Health Care October 5, 2012

13 Physician Performance Expectations The following are expectations for physicians at the Advocate Medical Group: General Be consistently respectful, polite, and professional in working with reception, nurses, answering service and other staff members who manage appointment scheduling and patient flow. Avoid appointment cancellations and changes to schedule except for professional and unavoidable reasons; give reasonable advance notice prior to scheduling vacation or other planned time off. Return calls from other physicians and other health providers as quickly as possible; respond to all pages within a reasonable period to time. Be available by pager or phone after office hours; if unavailable, notify answering service. Complete chart notation in a timely fashion, including appropriate coding of diagnoses and procedures. Arrive on time for the first appointment (unless unavoidably detained for professional reasons) and make every effort to stay on schedule throughout the day. Ensure legibility of handwritten notes; provide accurate and complete medical record documentation that meets clinical and regulatory requirements. Act in accord with the Advocate Code of Business Conduct and Advocate Conflict of Interest Policy, including adherence to guidelines and policies on coding and documentation. Patient Relations Standards Always strive to maintain the dignity, comfort and satisfaction of patients and family members. Listen to the patient, hear what they are saying, and respond appropriately. Greet patients in a congenial manner and with a smile when appropriate; apologize if you are behind schedule. 2

14 AMG Advocate Care Index Handout Advocate Health Care

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17 30% 16% ER Visits by Level 1% 12% 41% EMERGENCY DEPT VISIT EMERGENCY DEPT VISIT EMERGENCY DEPT VISIT EMERGENCY DEPT VISIT EMERGENCY DEPT VISIT Top 11 ER Diagnoses In-Network Out-of-Network

18 ER Visits by Insurance Type HMO PPO 1187 In-Network Out-of-Network 700 All ER Visits by Age < In-Network Out-of-Network

19 1200 All ER Visits by Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday In-Network Out-of-Network 50 Readmissions per Age < In-Network Out-of-Network

20 Admissions by Service Type Medical Surgical Maternity Mental Health/Substance Abuse Non-Acute In-Network Out-of-Network %Out-of-Network Admissions for Top 10 Diagnoses 40% 35% 35% 36% 35% 30% 25% 22% 22% 20% 15% 10% 9% 13% 16% 14% 16% 5% 0%

21 % Out-of-Network Procedures for Admissions (Top 10) 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 15% 12% 17% 11% 27% 29% 18% 28% 26% 38%